7. PROJECT SUMMARY/ABSTRACT The proposed study would adapt and test both the efficacy and effectiveness of an online, telehealth intervention to improve parenting skills and subsequent early childhood behavior in a high-risk sample of opioid-using mothers. We will examine the efficacy of the Family Check-Up Online (FCU-Online), an evidence- based intervention to reduce behavior problems and support successful development and adaptation from early childhood to adolescence. The FCU-Online program will be adapted to include content focused on early childhood parenting skills and family health routines for high-risk mothers, and will be delivered to families in rural Oregon in a hybrid efficacy-effectiveness design. Focus groups that include both parents and community stakeholders will guide the adaptation of the curricula. A study population of 300 young children ages 2?5 years and their opioid-using mothers will be randomly assigned to receive either the intervention or community services as usual. The intervention will be delivered online as a telehealth model in order to reach families in rural and outlying areas. Adhering to a developmental?ecological model, we will test pathways to improved behavioral outcomes in children that include parenting skills and maternal executive functioning/self regulation as key mediators in the relation between early risk and reduction of problem behavior, consistent with the larger conceptual model of the PWO Prevention Center. Our investigative team is multidisciplinary and includes expertise in community interventions, parenting skills, rural health, online intervention development, and health disparity. The study will significantly contribute to our understanding of effective parenting interventions during early childhood with high-risk, opioid-using mothers to enhance long-term reductions in child problem behavior and ultimately, reduce adult substance abuse.